Is it reasonable to repair a ruptured globe at the slit-lamp microscope in this case? The patient has a blind eye from prior pathology and fell and sustained this large, limbus-to-limbus corneal laceration. For whatever reason, it is a big challenge to get this patient to the operating room for a ruptured globe repair under anesthesia. In this case is it reasonable and prudent to repair it at the slit-lamp microscope in your clinic?
While repairing a ruptured globe, specifically a corneal laceration in a blind eye, at a slit lamp is unconventional, it is a vital skill in resource-limited or extreme emergency settings. Unlike the supine positioning of an operating room, the slit lamp requires the patient to remain upright and relatively still. The primary challenge is the lack of a sterile field and the difficulty of managing high intra-ocular pressure or uveal prolapse without general anesthesia. However, the slit lamp provides good coaxial illumination and magnification, allowing for precise needle passes with 10-0 nylon sutures. Surgeons can use a hand-over-hand technique to stabilize the globe while navigating the narrow working distance between the objective lens and the patient’s eye. While the OR remains the gold standard for safety and infection control, the slit lamp serves as a reasonable alternative when immediate surgical intervention is required to restore anatomical integrity and prevent further vision loss. What is your opinion? Please comment below.
